Sexual Recovery After Radiation For #Prostate Cancer | #MarkScholzMD #AlexScholz #PCRI

追加: 2026-06-04

[00:00:00]In today's video, we are talking about recovering sexual function after radiation. Men who are embarking upon radiation may not realize that it actually takes some time before these types of side effects may pop up, >> [music] >> and they need to know what would you need to do in order to recover sexual function. What do you need to look for and watch out for and what can be done?

[00:00:18]So, today we're going to talk to Dr. Mark Schulz. He's a 30-year medical oncologist who is focused solely on prostate cancer [music] and get his take on the matter.

[00:00:28]So, in today's video, we're talking about sexual recovery after radiation.

[00:00:32]In a previous video, we covered sexual recovery after surgery, so this is kind of a little bit of a theme, but I think that many men embark upon treatment and they don't know what's ahead as far as sexual and urinary function. And these prostate cancer treatments definitely affect those two. So, just starting from the beginning, how does radiation affect sexual function? Well, it's quite a kind of distinction from surgery because with surgery, men go through an operation and they're instantly rendered impotent, then they slowly recover if they recover over a period of months. And men who go through radiation, it's rare for them to develop immediate erectile dysfunction. Uh if people uh run into erectile dysfunction from radiation, it's something that could come on over a period of 1 to 20 months after the treatment. They say if you get out 24 months and nothing has happened, your risk is the same as other people of your age group. So, the dynamics are very different. And uh but the reality is that uh the men who are undergoing radiation treatment to their whole prostate, typical standard radiation, uh are going to encounter a 20 to 50-plus percent chance of serious erectile dysfunction that does not respond to Cialis and Viagra within a year or two. The 20 to 50% risk is variable depending on their age and how functional they were prior to with radiation. So, if a man does have radiation, is there anything that he should be doing in the meantime to ensure that maybe he has the best chance at recovery long-term since these side effects when it comes to sexual function don't happen until much later? Well, it's generally believed, although I can't tell you studies are unequivocally proving that the early use of Cialis and Viagra are helpful over the long term.

[00:02:17]Certainly, in men that start to notice a drop-off, uh those individuals should initiate Cialis or Viagra.

[00:02:24]But, many doctors are prescribing these things empirically and recommending that that the patients use them.

[00:02:31]The biggest issue with radiation is how frequently doctors are recommending that men take hormone therapy at the same time. And that installs a whole new dynamic in this difficulty with, you know, sexual function after radiation.

[00:02:47]Men are just getting radiation as a stand-alone, which is occasionally used, but often not. Often uh radiation is recommended in combination with hormone therapy.

[00:02:57]And this is one of the reasons that I've advocated strongly for seed radiation rather than beam radiation. The seed radiation doctors are able to deliver a higher dose of radiation into the prostate. Interestingly, that doesn't translate into higher ED rates, but it does translate into higher cure rates and uh certain percentage of men who have seed implants don't need to take hormone therapy in conjunction with their radiation. So, seed implant radiation, beam radiation.

[00:03:27]Beam radiation is often advocated uh in conjunction with hormone therapy, whereas seed radiation may or may not be advocated in conjunction with hormone therapy, but there are pretty strong arguments that in many cases men can do seed radiation without any hormone treatment. And the hormone treatment is a big offender in this world of erectile dysfunction. If men are starting on radiation therapy and hormone treatment during radiation and immediately after for several months, uh men's libido, their sex drive, their interest in sexual activity disappears completely.

[00:04:03]If they are on hormone therapy and they're not getting any nighttime erections, they can develop penile atrophy and long-term erectile dysfunction problems as a result of that.

[00:04:14]And unfortunately, while their libido is low, they're not really that concerned about it. So, these men are not initiating corrective actions during that time of hormone treatment by taking Cialis or Viagra or artificially inducing erections during that that time period of treatment. And uh this promotes a greater likelihood of developing long-term erectile dysfunction. Men who are doing radiation in conjunction with hormone therapy need to be on Cialis and Viagra, and they need to put a a schedule on their calendar to get erections a couple times a week so that the apparatus remains functional until the time when the hormone therapy ends and the sex drive returns and the natural nighttime erections come back.

[00:04:53]So, there's a button below this video.

[00:04:55]It says subscribe, and you should click that. There's two [music] reasons.

[00:04:58]Number one, it'll keep you up-to-date with all the new videos that we come out with, but number two, it'll help get these videos out to other prostate cancer [music] patients who have similar questions. It's important that we get this type of education out to people, so please click that [music] subscribe button. And if this video was helpful for you, please also push the like button. It helps us as well. Now, we have an in-person prostate cancer [music] patient conference coming up in September, and you can learn more at pcri.org/conference.

[00:05:24]It's a great way to get your questions answered in person, and we'd love to meet you and be there for you. It's a great opportunity. And also, if you would like to support us financially, you can do so at pcri.org/donate.

[00:05:32][music] That's a great way to support the work we do, as well. Now, back to my conversation with Dr. Scholz.

[00:05:39]You know, you have two different avenues. You have men who are just doing the radiation versus radiation and hormone therapy. For the men who are just doing radiation, they've had the radiation, you're saying that, you know, if you see any drop-off, make sure you're taking Cialis and Viagra. If there's further drop-off, what do they do? Yeah, the interesting thing is that, you know, men can be sexually active right after radiation therapy and often times hear from my clients that this is part of their normal everyday life and it just carries on.

[00:06:06]The management of erectile dysfunction for men who who as a result of radiation are discovering, you know, some months after radiation perhaps that they can't get an erection, they're taking full dose Cialis or Viagra and things aren't functioning.

[00:06:19]The policies at that juncture are the same as they are for any man that develops erectile dysfunction as they get older.

[00:06:26]Prior to the advent of Cialis and Viagra, you know, half of the men in their 60s had developed erectile dysfunction just from progressive aging. And so, there's a whole industry that works around trying to help men recover normal sexual romantic life when this happens.

[00:06:43]And that's not my primary expertise, but you have injection therapy which we talked about more extensively in our video on recovering after surgery.

[00:06:53]You have penile prostheses, vacuum pumps.

[00:06:58]There's other methodologies that are implemented to try and help people recover their normal romantic lifestyle.

[00:07:04]One of the things that I think is not often mentioned is that surgery will take away the production of the liquid when it comes to ejaculation and I think that that's something that surprises a lot of men that they don't all of a sudden they're not able to produce that.

[00:07:21]And so, is this a conversation that you're, you know, telling patients about ahead of time because even one of the doctors in your practice even talks about sperm banking for men who are younger. I know it's not a super common thing, but I think it is something to be addressed.

[00:07:34]>> Yeah, it is something that can get lost in the shuffle and it's not just surgery. Radiation therapy also causes men to have dry orgasms after the treatment. This doesn't mean that they can't father children, although it's done unnaturally through artificial insemination. You can get sperm out of a man's testicles after he's had radiation or surgery, and a woman can be made pregnant from those that insemination.

[00:07:58]The natural process of intercourse making people pregnant is very unlikely to happen because of the dry orgasms.

[00:08:04]Yeah, it's something that I think is also a conversation that it's important for men going on radiation to talk about with their partners ahead of time because I know that that was kind of an unexpected thing. So, I appreciate you talking about that. Now, when it comes to men who have had radiation and are embarking upon hormone therapy, there's two different things here. It's not just the function, but it's like you said, the interest in sex. So, we're talking about libido versus potency. So, how does a man who isn't interested, you know, is it more of a mechanical thing, a schedule thing? How are you counseling your patients who don't have an interest and then are starting to see function maybe fall off?

[00:08:42]>> Right. Well, they may not notice it function is falling off until it's too late. And so, the methodology that I you know, I just put this on the schedule when I'm talking with newly diagnosed patients who are in the process of implementing hormone therapy as part of their curative protocol, that this treatment's going to be a temporary treatment, but during that treatment that it's going to place your long-term function at in danger of permanent problems.

[00:09:07]And so, it's usually counseling with the couple. And yes, a red X on the on the calendar twice a week that we will take some Viagra, will manufacture an erection through some means as a form of exercise. Just like we're telling patients to exercise regularly the other muscles in their body, we routinely tell people get a trainer, get to the gym, lift weights 3 days a week to compensate for the muscle loss that goes along with losing testosterone. So, muscles need to be used to be maintained. There's a musculature in the penis that causes the erections that will atrophy if it is not periodically used. I think one comment that I read was talking specifically about shrinkage and so they were surprised that they had shrinkage from the surgery itself, which isn't normally talked about. I think it's an important factor. Does that happen also in radiation or is that because of atrophy if they're not using it?

[00:10:00]>> You're talking about penile shrinkage and I don't think there's anyone that's proven that this is the ideology, but it's very logical that shrinkage that men are encountering after surgery and potentially after hormone therapy is due to the neglect of getting erections immediately after the surgery or during the hormone treatment to keep things in a normal functional way. We see it. It's quite dramatic in men who are unwilling to do any type of fitness training when they're on The amount of muscle loss is shocking. Men can lose 30 or 40% of their muscle when the testosterone goes away. And so, it shouldn't surprise us that erections are caused by a musculature in the penis that that is also going to atrophy and shrink. There may be somebody who's watching this video who had radiation and has already had atrophy.

[00:10:44]Is there a recovery process? Can you get it back? Is it permanently gone? Does this one prosthesis come into play? What can be done? Well, prosthesis are usually recommended for men who've become impotent and don't want to do injection therapy as we've talked about in the surgical video. It's not for restoring the size of their the men's erection. It's so that they can get functional erections. I'm not aware of any recovery process and this is why it's so important, I think, for people to pay attention to this up front. If this process of atrophy is allowed to, you know, go forward without any compensatory intervention, it's generally permanent. So, we talked about penile injections in other videos and one of the things we're going to, you know, highlight is Dr. John Mulhall's videos, which he he wrote the book, you know, um sexual health after surgery and radiation. And so we'll be linking that in the comments section, but one of the things about, you know, injection therapy is it sounds very intimidating.

[00:11:38]A lot of men don't get the training that they need, um and so it's important to advocate in those doctors' offices for that, but, you know, it's a from what I've heard, a small needle placed into the base of the penis, and then they're able to get um an erection from that.

[00:11:52]So, that's kind of a a process that we do see men who have had radiation or radiation hormone therapy doing as part of this protocol that you're talking about. I haven't had a lot of feedback on the prosthesis um experience. So, you've had patients who have had this, how has it worked out for them? So, when men get an operation to try and correct erectile dysfunction that apparently it's you know, that ship has sailed.

[00:12:17]They've tried injections, maybe those aren't working or they're unwilling, or they uh they've tried Viagra and Cialis, they can't get erections, but they want to uh resurrect their romantic life. There are devices that can be surgically implanted in the penis. These are sophisticated uh devices. They have like a little switch that they put in the in the scrotum, and it's powered by the heat of your body. It's where they can have erections that come and go in a natural fashion, and cosmetically, it's difficult to tell if not impossible that uh an individual has this even if they're involved in in sexual activity.

[00:12:51]This is pretty exciting that that uh modern medicine has been able to bring about a a resource like this that really really does work. It is super important, of course, as a very sensitive area of the body, uh to solicit um these types of operations from doctors that are 100% all in, just doing this type of surgery all the time. When patients solicit uh assistance from those highly skilled experts, uh the results are good. About 80 to 90, probably 90% of men are very pleased with the outcomes.

[00:13:22]Um what's the 10%? Well, anytime you have a foreign body, if it gets infected or if there's complications, boy, you're back in a very sensitive area of the body, and it's it's rather frightening.

[00:13:32]But, these uh penile prostheses are effective, and uh the satisfaction of from them is good for people who go to the quality centers to have them implanted. Now, the last question is from a man who had radiation. He also had hormone therapy. He's off of hormone therapy. He is on a schedule, however, he just doesn't feel like his libido is there. Like, he's really not still interested in sex. It's not recovering the way he thought it would. And so, he asked about testosterone replacement therapy. How often do you see this play out with patients who are trying to recover sexual function after radiation?

[00:14:07]We see it a lot. The problem in aging men, especially when we were using a lot of Lupron, now we're using a bit more Orgovyx, which has more predictable testosterone recovery. Lupron often will uh leave people with sort of half-recovered testosterone levels. The other problem is that our our sexual life is partly memory, and uh for men to take an extended holiday from any sexual activity, not even thinking sexual thoughts, uh even when their testosterone comes back to a full degree, I've noticed that a certain percentage of men who just don't come back with the same interest level. They've taken a holiday. Their energy to pursue sexual uh activity isn't what it was prior.

[00:14:46]Uh it's a hard thing to quantify, but it's definitely a reality. Rebuilding a romantic uh uh mentality, uh certainly if testosterone levels are low, you can uh supplement testosterone. I know there's doctors out there that, in my opinion, really don't know what they're talking about. You know, talk about testosterone fueling the cancer. Men, of course, have to be supervised for the rest of their life when they've had prostate cancer, but allowing testosterone to get back to normal levels is not going to change someone's prognosis if they're supervised by experts. For the men who have normal testosterone, or perhaps have taken testosterone and achieved normal testosterone levels, and who still have a uh low sex drive, there's a lot of um uh a lot of lay literature out there about how to to revive your your romantic life. I'm not an expert in those things, and I wouldn't really know um how to, you know, redirect people towards a better libido after they've gotten full testosterone recovery.

[00:15:40]That's an art. I don't know that I've I've figured that one out.

[00:15:44]There's a couple of key things to think about from my conversation with Dr. Schulz. So, one is that if you're a man who has had radiation and maybe you haven't seen a drop-off in sexual function, that's great. I would still create a calendar or some sort of reminding system in order to make sure you're having erections once or twice a week, especially if you're on hormone therapy. Maybe it's putting a calendar alert, maybe it is talking to your partner about it and having them remind you. It's just important that you maintain function. I think sometimes function kind of drops off and men don't really speak up about it right away, and then it becomes more of an issue, and that's when it's brought up. But with injection therapy, it's important to start as soon as possible because you want to maintain the ability to use those muscles, and so it is important.

[00:16:28]Um another thing is if you are someone who needs to have injection therapy or you're looking into it, one thing is to speak up about it in your doctor's office, and you don't if you don't feel like they're giving you enough time, ask them for more time, or ask them to for maybe a supporting um staff member to give you more time.

[00:16:44]It is important to learn how to do these properly. Number two is if you're uncomfortable with who's in the room, ask them to leave. I need to have a private conversation between me and my doctor right now. Um can you go ahead and leave? And And I think that that's important that you make space and make time to learn how to do this because it is a bit of a learning curve, and it's important to get the proper education ahead of time. Now, we've I know hundreds of men who have had penile injections, and they have been able to figure out what works for them, the right dosage. It does take time.

[00:17:13]Sometimes it's too little, sometimes it's too much. What we want to avoid is that you do it once and then just quit because it wasn't the experience that you were expecting. It isn't like it does take time to research what works for you as an individual. And so, make sure that you keep having those conversations with your doctor. I'm going to go ahead and link the conversation that I had with John Sharon. He is a helpline facilitator here with PCRI and he does a great job talking about his experience, the experience of other men who he's talked to on helpline, and talking about the details that men need to know about in order to administer these types of injections. Another thing I'm going to link is a doctor named John Mulhall. He calls himself the penis doctor and this is just what he does. He wrote a book called Save Your Sex Life and he fully focuses on maintaining or recovering sexual function after surgery, radiation, or other prostate cancer treatments. And he did some incredible interviews with PCRI at our conferences and I'm going to link his uh videos in the comment section as well as another doctor, Dr. Jeff Brady. Um he has done an incredible job as well just working with men on recovering function, vacuum pumps, you know, all the different types of um methods like prosthesis and different things like that. And so, we're going to go ahead and link those in the comment section below.

[00:18:24]Encouraging I just want to encourage you to continue your research. Continue to find options. If something doesn't work right away, keep researching or go to the next one. Talk about it in your doctor's offices um and make sure you also have clear goals with your partner.

[00:18:38]I was on a prostate cancer ad board the other day. I was on there with nine different prostate cancer patients of varying um treatments. Most of them had been treated with either surgery or radiation. Some were on hormone therapy, some weren't. But they were talking about the impact that it had and two of the guys on there were divorced. And he said that he was a young guy, he had radiation, it affected his sexual function, the communication just wasn't happening, there were other issues and it really caused a problem.

[00:19:06]Obviously, this is not the most common thing, but it does lead to a conversation where it's important to talk to your partner about what sex is going to look like now. And what does intimacy look like? What does the conversation of uh penile injections, what is the expectations of that? There's just so many different factors and so I don't want to overwhelm you, but I do want to encourage you. If you are choosing a treatment, make sure to have your partner in on that conversation. And just let them know, this is going to be a little bit different. Here's what we can expect. We won't have um the ability to um you know, orgasm maybe the same way. Or maybe we do need to take an injection.

[00:19:46]Or I'm going to take these pills is going to be the timeline. Um I think it's important that if you're going to have dry ejaculation, some caregivers and some partners are um kind of surprised by that. So just make sure that you were communicating. You know, sex may look different after treatment.

[00:20:01]But I know so many men who have recovered it, they figured it out, they figured out a different way a little bit to um the timing, the schedule, uh the conversations that they need to have and how to enjoy it again. And I think that that's something worth pursuing. So um if you have further questions, you can contact our helpline at pcri.org/helpline.

[00:20:19]These are men who have dealt with these issues, they've dealt with treatment and what this looks like. They're very amazing people cuz they're open about their experiences [music] and they're willing to speak up about it and talk to you about it. And so you can talk to them via phone or email, uh whatever your preference is and go ahead and um submit [music] your form there.

[00:20:36]And also go ahead and make sure to click the links in the comment section because this is a great way to [music] continue your education. Now please remember most of all, you're not alone and I hope you have a great week.